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BackgroundGlobally, almost 15 million infants are born prematurely each year, disproportionately affecting low and middle-income countries. In the absence of mother's milk, the World Health Organization recommends using donor human milk (DHM) due to its protective effect against necrotizing enterocolitis, a life-threatening intestinal disorder. The use of DHM is increasing globally, with many low and middle-income countries integrating donor milk banks into their public health strategies to reduce neonatal mortality, yet very little is known about the nutritional composition of DHM. Additional knowledge gaps include how DHM composition is influenced by milk banking practices, and whether preterm nutrient recommendations are achieved when DHM is used with commercially available fortifiers.MethodsWe designed a multi-site study with eight geographically diverse milk bank partners in high, middle, and low-income settings that will examine and compare a broad range of nutrients and bioactive factors in human milk from 600 approved milk bank donors around the world to create comprehensive, geographically diverse nutrient profiles for DHM. We will then simulate the random pooling of 2 to 10 donors to evaluate the impact of pooling as a potential strategy for milk banks to manage nutrient variability in DHM. Finally, we will evaluate whether commercially available fortifiers meet nutrient recommendations when used with DHM.DiscussionWe expect that results from this study will improve nutritional care globally for the growing number of preterm infants who receive donor human milk.

Donor human milk is recommended by the World Health Organization both for its advantageous nutritional and biological properties when mother's own milk is not available and for its recognized support for lactation and breastfeeding when used appropriately. An increasing number of human milk banks are being established around the world, especially in low- and middle- income countries, to facilitate the collection, processing and distribution of donor human milk. In contrast to other medical products of human origin, however, there are no minimum quality, safety and ethical standards for donor human milk and no coordinating global body to inform national policies. We present the key issues impeding progress in human milk banking, including the lack of clear definitions or registries of products; issues around regulation, quality and safety; and ethical concerns about commercialization and potential exploitation of women. Recognizing that progress in human milk banking is limited by a lack of comparable evidence, we recommend further research in this field to fill the knowledge gaps and provide evidence-based guidance. We also highlight the need for optimal support for mothers to provide their own breastmilk and establish breastfeeding as soon as and wherever possible after birth. Lorsque la mere est dans l'impossibilite d'allaiter, l'Organisation mondiale de la Sante recommande d'opter pour le lait humain provenant de donneuses, tant pour ses proprietes nutritionnelles et biologiques que pour la contribution averee qu'il apporte a la lactation et a l'allaitement quand il est utilise a bon escient. Un nombre croissant de banques de lait humain s'etablissent dans le monde entier, en particulier dans les pays a faible et moyen revenu, afin de faciliter la collecte, le traitement et la distribution de lait humain provenant de donneuses. Cependant, contrairement a d'autres produits medicaux d'origine humaine, il n'existe aucune norme minimale de qualite, de securite et d'ethique en la matiere, et aucun organe de coordination global n'a ete cree pour guider les politiques nationales. Dans le present document, nous evoquons les principaux obstacles a la progression des banques de lait humain, notamment l'absence de definition claire ou de registre de produits; les problemes relatifs a la reglementation, la qualite et la securite; ainsi que les questions ethiques entourant la commercialisation et l'exploitation potentielle des femmes. Jugeant cette progression limitee par le manque de donnees comparables, nous encourageons a mener d'autres recherches dans ce domaine pour combler les lacunes et fournir des orientations fondees sur des preuves. Nous soulignons egalement la necessite d'offrir un soutien optimal aux meres afin qu'elles puissent produire leur propre lait et allaiter autant que possible immediatement apres la naissance. La Organizacion Mundial de la Salud recomienda la leche humana donada tanto por sus ventajosas propiedades nutricionales y biologicas cuando no se dispone de la propia leche materna como por su reconocido apoyo a la lactancia y al amamantamiento cuando se utiliza de manera adecuada. Cada vez se crean mas bancos de leche humana en todo el mundo, sobre todo en los paises de ingresos bajos y medios, para facilitar la recogida, el procesamiento y la distribucion de leche humana donada. Sin embargo, a diferencia de lo que ocurre con otros productos medicos de origen humano, no existen estandares minimos de calidad, seguridad y etica para la leche humana donada ni un organismo mundial de coordinacion que sirva de base a las politicas nacionales. En este documento se exponen los principales problemas que impiden el progreso de los bancos de leche humana, como la falta de definiciones claras o de registros de productos; los problemas relacionados con la regulacion, la calidad y la seguridad; y las preocupaciones eticas sobre la comercializacion y la posible explotacion de las mujeres. Dado que el progreso de los bancos de leche humana se ve limitado por la falta de evidencias comparables, se recomienda seguir investigando en este campo para compensar los vacios de conocimiento y proporcionar una guia asistencial. Asimismo, se destaca la necesidad de apoyar al maximo a las madres para que se provean de su propia leche materna y establezcan la lactancia materna tan pronto y siempre que sea posible despues del nacimiento. [phrase omitted], Introduction The World Health Organization (WHO) recommends donor human milk for low- and very-low-birthweight infants, as well as small and sick newborns who cannot be fed their mother's own milk. [...]

Human milk provides essential nutrition for infants and holds many health benefits for infants and mothers. When a mother's own milk is not available for her infant, the World Health Organization recommends feeding donor human milk (DHM) from a human milk banking facility. DHM is human milk produced, collected then donated to a human milk bank (HMB). HMBs serve many vital functions, including screening donor mothers, then collecting, processing, storing, and allocating DHM to recipients. The first HMB opened in 1909, and today there are more than 700 HMBs globally. Unfortunately, HMB facilities are not present in all locales, with notable gaps in South Asia and Africa. Additionally, there are no global standards to guide HMB operational procedures. Even though most HMBs attempt to employ quality control systems to provide safe DHM, differences in community needs, resource availability, and a range of methods and policies to execute processes result in significant variations in DHM quality and HMB operations. Robust and collaborative systems that ensure safe and equitable access to DHM are needed. In this paper, we present a global snapshot of current human milk banking practices; review an interdisciplinary framework to guide and support HMB activities as an integrated part of health and newborn care systems; discuss factors that contribute to HMB sustainability; outline barriers to scaling HMBs worldwide; and highlight knowledge, policy, and research gaps. Developing global HMB guidance and rigorous, adaptable standards would strengthen efforts to improve newborn health. Key messages: Safe donor human milk (DHM) from a human milk bank (HMB) is a WHO recommendation when the mother's own milk is not available.Over 700 HMBs exist globally, with varying operational models and a wide range of practices due to lack of global guidelines and the current practice of adaptation to local needs and health systems.Scaling up of HMBs to meet the global demand for DHM would be facilitated by the development of global standards to guide integration with breastfeeding promotion and quality controlled processing to ensure provision of safe DHM. [ABSTRACT FROM AUTHOR]

We assessed the potential effectiveness of human milk banking and lactation support on provision of human milk to neonates admitted in the newborn unit (NBU) at Pumwani Maternity Hospital, Kenya. This pre–post intervention study collected data from mothers/caregivers and their vulnerable neonates or term babies who lacked sufficient mother's milk for several reasons admitted in the NBU. The intervention included establishing a human milk bank and strengthening lactation support. Preintervention data were collected between 5 October 2018 and 11 November 2018, whereas postintervention data were collected between 4 September 2019 and 6 October 2019. Propensity score‐matched analysis was performed to assess the effect of the intervention on exclusive use of human milk, use of human milk as the first feed, feeding intolerance and duration of NBU stay. The surveys included 123 and 116 newborns at preintervention and postintervention, respectively, with 160 newborns (80 in each group) being included in propensity score matched analysis. The proportion of neonates who exclusively used human milk during NBU stay increased from 41.3% preintervention to 63.8% postintervention (adjusted odds ratio [OR]: 2.68; 95% confidence interval [CI]: 1.31, 5.53) and those whose first feed was human milk increased from 55.0% preintervention to 83.3% postintervention (adjusted OR: 5.09; 95% CI: 2.18, 11.88). The mean duration of NBU stay was 27% (95% CI: 5.8%, 44.0%) lower in the postintervention group than in the preintervention group. The intervention did not affect feeding intolerance. Integrating human milk banking and lactation support may improve exclusive use of human milk among vulnerable neonates in a resource limited setting. Key messages: Mother's milk is recommended for feeding preterm and low birthweight neonates.However, when the provision of mother's milk is not feasible, the use of donor human milk—from a human milk bank—is recommended.In this quasi‐experimental study, human milk banking and lactation support intervention increased the exclusive use of human milk during hospital stay and the use of human milk as the first feed among neonates admitted in the newborn unit at Pumwani Maternity Hospital, Kenya.The intervention also reduced the duration of stay in the newborn unit and there was no impact on feeding intolerance.Human milk banking and lactation support may improve the exclusive use of human milk among vulnerable neonates in a resource‐limited setting. [ABSTRACT FROM AUTHOR]

If maternal milk is unavailable, the World Health Organization recommends that the first alternative should be pasteurised donor human milk (DHM). Human milk banks (HMBs) screen and recruit milk donors, and DHM principally feeds very low birth weight babies, reducing the risk of complications and supporting maternal breastfeeding where used alongside optimal lactation support. The COVID‐19 pandemic has presented a range of challenges to HMBs worldwide. This study aimed to understand the impacts of the pandemic on HMB services and develop initial guidance regarding risk limitation. A Virtual Collaborative Network (VCN) comprising over 80 HMB leaders from 36 countries was formed in March 2020 and included academics and nongovernmental organisations. Individual milk banks, national networks and regional associations submitted data regarding the number of HMBs, volume of DHM produced and number of recipients in each global region. Estimates were calculated in the context of missing or incomplete data. Through open‐ended questioning, the experiences of milk banks from each country in the first 2 months of the pandemic were collected and major themes identified. According to data collected from 446 individual HMBs, more than 800,000 infants receive DHM worldwide each year. Seven pandemic‐related specific vulnerabilities to service provision were identified, including sufficient donors, prescreening disruption, DHM availability, logistics, communication, safe handling and contingency planning, which were highly context‐dependent. The VCN now plans a formal consensus approach to the optimal response of HMBs to new pathogens using crowdsourced data, enabling the benchmarking of future strategies to support DHM access and neonatal health in future emergencies. [ABSTRACT FROM AUTHOR]

The article offers information on reduction of newborn mortality through improved newborn care is a global health priority. Topics include improved global recognition and alignment of newborn care practices, including Every Newborn Action Plan (World Health Organization [WHO] & United Nations Children's Fund [UNICEF], and Early Essential Newborn Care.

Objective: The prevention of malnutrition in children under two approach (PM2A), women's empowerment and agricultural interventions have not been widely evaluated in relation to child diet and nutrition outcomes. The present study evaluated the effectiveness of PM2A, women's empowerment groups (WEG), farmer field schools (FFS) and farmer-to-farmer training (F2F).Design: Community-matched quasi-experimental design; outcome measures included children's dietary diversity, stunting and underweight.Setting: Communities in South Kivu, Democratic Republic of the Congo.ParticipantsA total of 1312 children from 1113 households.Results: Achievement of minimum dietary diversity ranged from 22·9 to 39·7 % and was significantly greater in the PM2A and FFS groups (P<0·05 for both comparisons). Fewer than 7·6 and 5·8 % of children in any group met minimum meal frequency and acceptable diet targets; only the PM2A group differed significantly from controls (P<0·05 for both comparisons). The endline stunting prevalence ranged from 54·7 % (PM2A) to 69·1 % (F2F) and underweight prevalence from 22·3 % (FFS) to 34·4 % (F2F). No significant differences were found between intervention groups and controls for nutrition measures; however, lower prevalences of stunting (PM2A, -4 %) and underweight (PM2A and FFS, -7 %) suggest potential impact on nutrition outcomes.Conclusions: Children in the PM2A and FFS groups had better child diet measures and nutrition outcomes with the best results among PM2A beneficiaries. Interventions that address multiple aspects nutrition education, health, ration provision and income generation may be more effective in improving child diet and nutrition in resource-poor settings than stand-alone approaches. [ABSTRACT FROM AUTHOR]

Background: Human milk oligosaccharides (HMOs) have important protective functions in human milk. A low-cost remote pasteurisation temperature-monitoring system has been designed using FoneAstra, a cell phone-based networked sensing system to monitor simulated flash heat pasteurisation. Aim: To compare the pasteurisation effect on HMOs of the FoneAstra FH method with the current Sterifeed Holder method used by human milk banks. Methods: Donor human milk samples (n = 48) were obtained from a human milk bank and pasteurised using the two pasteurisation methods. HMOs were purified from samples and labelled before separation using high-performance liquid chromatography. Concentrations of total HMOs, sialylated and fucosylated HMOs and individual HMOs using the two pasteurisation methods were compared using repeated-measures ANOVA. Results: The study demonstrated no difference in total concentration of HMOs between the two pasteurisation methods and a small but significant increase in the total concentration of HMOs regardless of pasteurisation methods compared with controls (unpasteurised samples) (p<0.0001). Conclusion: The FoneAstra FH pasteurisation system does not negatively affect oligosaccharides in human milk and therefore is a possible alternative for providing safely sterilised human milk for low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Globally, increasing rates of facility-based childbirth enable early intervention for small vulnerable newborns. We describe health system-level inputs, current feeding, and discharge practices for moderately low birthweight (MLBW) infants (1500-<2500g) in resource-constrained settings. The Low Birthweight Infant Feeding Exploration study is a mixed methods observational study in 12 secondary- and tertiary-level facilities in India, Malawi, and Tanzania. We analyzed data from baseline facility assessments and a prospective cohort of 148 MLBW infants from birth to discharge. Anthropometric measuring equipment (e.g., head circumference tapes, length boards), key medications (e.g., surfactant, parenteral nutrition), milk expression tools, and human milk alternatives (e.g., donor milk, formula) were not universally available. MLBW infants were preterm appropriate-for-gestational age (38.5%), preterm large-for-gestational age (3.4%), preterm small-for-gestational age (SGA) (11.5%), and term SGA (46.6%). The median length of stay was 3.1 days (IQR: 1.5, 5.7); 32.4% of infants were NICU-admitted and 67.6% were separated from mothers at least once. Exclusive breastfeeding was high (93.2%). Generalized group lactation support was provided; 81.8% of mother-infant dyads received at least one session and 56.1% had 2+ sessions. At the time of discharge, 5.1% of infants weighed >10% less than their birthweight; 18.8% of infants were discharged with weights below facility-specific policy [1800g in India, 1500g in Malawi, and 2000g in Tanzania]. Based on descriptive analysis, we found constraints in health system inputs which have the potential to hinder high quality care for MLBW infants. Targeted LBW-specific lactation support, discharge at appropriate weight, and access to feeding alternatives would position MLBW for successful feeding and growth post-discharge., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Semrau et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)